General Practice and Primary Care - Research Publications
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ItemNo Preview AvailableBest Practice During Teleconsultations With Adolescents: A Scoping Review(ELSEVIER SCIENCE INC, 2022-05)PURPOSE: Teleconsultations are increasingly used to deliver health care, yet guidance on how to maximize health outcomes and ensure the quality and rights-based principles of adolescent health care during teleconsultations is lacking. This scoping review synthesized the literature on teleconsultations with adolescents, with the objective of informing a practical guidance for healthcare professionals. METHODS: Eight databases were searched to identify articles published between 2010 and 2020 in English, French, or Spanish that provided evidence or guidance on synchronous teleconsultations with 10- to 19-year-olds. Web sites in six high-income countries and six low- to middle-income countries were also searched and a Google search was conducted. Data were analyzed using narrative synthesis. RESULTS: Of 59 total references, 51 were from high-income countries. References included primary research (n = 21), reviews (n = 13), clinical guidance (n = 9), case reports (n = 9), commentaries (n = 6), and a website (n = 1). Just under half (46%) were descriptive, qualitative, or expert opinion. The main focus was mental health and behavioral disorders. DISCUSSION: Good evidence on the complexities of conducting teleconsultations with adolescents is lacking. Questions remain regarding the scope and acuity of health issues for which teleconsultations are appropriate, their role in overcoming or contributing to inequalities, and the practicalities of conducting consultations.
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ItemEconomic evaluation of the Target-D platform to match depression management to severity prognosis in primary care: A within-trial cost-utility analysis(PUBLIC LIBRARY SCIENCE, 2022)BACKGROUND: Target-D, a new person-centred e-health platform matching depression care to symptom severity prognosis (minimal/mild, moderate or severe) has demonstrated greater improvement in depressive symptoms than usual care plus attention control. The aim of this study was to evaluate the cost-effectiveness of Target-D compared to usual care from a health sector and partial societal perspective across 3-month and 12-month follow-up. METHODS AND FINDINGS: A cost-utility analysis was conducted alongside the Target-D randomised controlled trial; which involved 1,868 participants attending 14 general practices in metropolitan Melbourne, Australia. Data on costs were collected using a resource use questionnaire administered concurrently with all other outcome measures at baseline, 3-month and 12-month follow-up. Intervention costs were assessed using financial records compiled during the trial. All costs were expressed in Australian dollars (A$) for the 2018-19 financial year. QALY outcomes were derived using the Assessment of Quality of Life-8D (AQoL-8D) questionnaire. On a per person basis, the Target-D intervention cost between $14 (minimal/mild prognostic group) and $676 (severe group). Health sector and societal costs were not significantly different between trial arms at both 3 and 12 months. Relative to a A$50,000 per QALY willingness-to-pay threshold, the probability of Target-D being cost-effective under a health sector perspective was 81% at 3 months and 96% at 12 months. From a societal perspective, the probability of cost-effectiveness was 30% at 3 months and 80% at 12 months. CONCLUSIONS: Target-D is likely to represent good value for money for health care decision makers. Further evaluation of QALY outcomes should accompany any routine roll-out to assess comparability of results to those observed in the trial. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000537459).
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ItemPrimary care consumers' experiences and opinions of a telehealth consultation delivered via video during the COVID-19 pandemic(CSIRO PUBLISHING, 2022)This study examined consumers' experiences and opinions of a videoconference with a primary healthcare professional, and estimated the value of travel and time savings for consumers compared with face-to-face consultations. The online survey was conducted in Melbourne, Australia, between October 2020 and May 2021. The sample (n = 499) was highly educated (Bachelor degree or higher, 79%; 393/499), predominately female (70%; 347/499), mainly spoke English at home (78%; 390/499) and had a mean age of 31.8 years (s.d. 11.40). Reduced travel time (27%; 271/499) and avoiding exposure to COVID-19 (23%; 228/499) were the main reasons consumers chose a videoconference. Mental health and behavioural issues were the main reason for the consultation (38%; 241/499) and 69% (346/499) of consultations were with a general practitioner. Perceptions of the quality of care were uniformly high, with 84% (419/499) of respondents believing videoconference was equivalent to a face-to-face consultation. No association was found between reporting that telehealth was equivalent to a face-to-face consultation and education, language, health status, reason for consultation or provider type. The average time saved per consultation was 1 h and 39 min, and the average transport-related saving was A$14.29. High rates of acceptance and substantial cost savings observed in this study warrant further investigation to inform the longer-term role of videoconferences, and telehealth more broadly, in the Australian primary care system.
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ItemMatching depression management to severity prognosis in primary care: results of the Target-D randomised controlled trial(ROYAL COLL GENERAL PRACTITIONERS, 2021-02)BACKGROUND: Mental health treatment rates are increasing, but the burden of disease has not reduced. Tools to support efficient resource distribution are required. AIM: To investigate whether a person-centred e-health (Target-D) platform matching depression care to symptom severity prognosis can improve depressive symptoms relative to usual care. DESIGN AND SETTING: Stratified individually randomised controlled trial in 14 general practices in Melbourne, Australia, from April 2016 to February 2019. In total, 1868 participants aged 18-65 years who had current depressive symptoms; internet access; no recent change to antidepressant; no current antipsychotic medication; and no current psychological therapy were randomised (1:1) via computer-generated allocation to intervention or usual care. METHOD: The intervention was an e-health platform accessed in the GP waiting room, comprising symptom feedback, priority-setting, and prognosis-matched management options (online self-help, online guided psychological therapy, or nurse-led collaborative care). Management options were flexible, neither participants nor staff were blinded, and there were no substantive protocol deviations. The primary outcome was depressive symptom severity (9-item Patient Health Questionnaire [PHQ-9]) at 3 months. RESULTS: In intention to treat analysis, estimated between- arm difference in mean PHQ-9 scores at 3 months was -0.88 (95% confidence interval [CI] = -1.45 to -0.31) favouring the intervention, and -0.59 at 12 months (95% CI = -1.18 to 0.01); standardised effect sizes of -0.16 (95% CI = -0.26 to -0.05) and -0.10 (95% CI = -0.21 to 0.002), respectively. No serious adverse events were reported. CONCLUSION: Matching management to prognosis using a person-centred e-health platform improves depressive symptoms at 3 months compared to usual care and could feasibly be implemented at scale. Scope exists to enhance the uptake of management options.
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ItemThe assertive cardiac care trial: A randomised controlled trial of a coproduced assertive cardiac care intervention to reduce absolute cardiovascular disease risk in people with severe mental illness in the primary care setting(ELSEVIER SCIENCE INC, 2020-10)BACKGROUND: Cardiovascular disease (CVD) accounts for 40% of the excess mortality identified in people with severe mental illness (SMI). Modifiable CVD risk factors are higher and can be exacerbated by the cardiometabolic impact of psychotropic medications. People with SMI frequently attend primary care presenting a valuable opportunity for early identification, prevention and management of cardiovascular health. The ACCT Healthy Hearts Study will test a coproduced, nurse-led intervention delivered with general practitioners to reduce absolute CVD risk (ACVDR) at 12 months compared with an active control group. METHODS/DESIGN: ACCT is a two group (intervention/active control) individually randomised (1:1) controlled trial (RCT). Assessments will be completed baseline (pre-randomisation), 6 months, and 12 months. The primary outcome is 5-year ACVDR measured at 12 months. Secondary outcomes include 6-month ACVDR; and blood pressure, lipids, HbA1c, BMI, quality of life, physical activity, motivation to change health behaviour, medication adherence, alcohol use and hospitalisation at 6 and 12 months. Linear mixed-effects regression will estimate mean difference between groups for primary and secondary continuous outcomes. Economic cost-consequences analysis will be conducted using quality of life and health resource use information and routinely collected government health service use and medication data. A parallel process evaluation will investigate implementation of the intervention, uptake and outcomes. DISCUSSION: ACCT will deliver a coproduced and person-centred, guideline level cardiovascular primary care intervention to a high need population with SMI. If successful, the intervention could lead to the reduction of the mortality gap and increase opportunities for meaningful social and economic participation. Trial registration ANZCTR Trial number: ACTRN12619001112156.
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ItemPatient reported self-help strategies and the perceived benefits for managing sub-threshold depressive symptoms: A nested qualitative study of Australian primary care attendees(WILEY, 2022-09-01)BACKGROUND: Subthreshold depression is common in primary care, but there is little information about the self-help strategies that patients use and the perceived benefits of these. AIM: This study sought to elicit the self-help strategies that primary care attendees identified as beneficial for the self-management of subthreshold depressive symptoms and the implications for general practitioners. METHOD: Semi-structured telephone interviews were conducted with 14 people (April-May 2017) from the Target-D randomised controlled trial (RCT). Target-D investigated whether using a patient-centred clinical prediction tool and an e-health platform to match mental health management options to prognosis was beneficial for improving depressive symptoms at 3 months compared to usual care. Interviews were thematically analysed to identify self-help strategies and their perceived benefits. RESULTS: Four overarching domains for the self-management strategies were identified: social, cognitive, behavioural and restorative. Interviewees reported using strategies across multiple domains, which included undertaking enjoyable, immersive activities, that provided relief from automatic negative thoughts and had a perceived cognitive benefit. Differences in the perceived sense of agency were noted around the self-regulation of mood, which indicated more explicit direction to patient-identified self-help management strategies by general practitioners for some may be of benefit in routine care. CONCLUSION: Some of the reported self-management strategies aligned with evidence-based approaches such as physical activity and mindfulness for mental health symptom management. These findings can inform low-intensity interventions within stepped care models for mental health in primary care, social prescribing models and, help to guide the management of patients by GPs for subthreshold depression.
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ItemA Mobile Phone App to Improve the Mental Health of Taxi Drivers: Single-Arm Feasibility Trial(JMIR Publications, 2020-01-15)Background: Psychological distress among taxi drivers is 5 times higher than that in the general population, and more than half of all drivers have experienced 3 or more potentially traumatic events in their lifetime. Nevertheless, help-seeking for mental health problems in this male-dominated, predominately immigrant workforce is low. Mobile technologies have the potential to increase mental health awareness, teach self-help skills, and encourage help-seeking in this hard-to-reach population. Objective: This study aimed to assess the feasibility, acceptability, and potential efficacy of Driving to Health, a mobile phone–friendly mental health website app designed for people working as taxi drivers. Methods: Drivers (n=46) were recruited from the Melbourne Airport Taxi Holding Yard to participate in a single-arm trial. Self-reported, paper-based assessments were completed at baseline and at 1 month. Feasibility was measured by completion rates, representativeness of study participants, and levels of use. Acceptability was assessed by measuring users’ perception of the quality of the app and anticipated levels of future use. The efficacy of Driving to Health to increase awareness, self-help behaviors, and intentions to seek help was assessed using the user version of the Mobile App Rating Scale (uMARS) and the General Help-Seeking Questionnaire (GHSQ). Psychological symptoms were measured using the short form of the Depression, Anxiety, and Stress Scale (DASS-21). Data were analyzed using complete case analysis. Results: In total, 42 participants comprising drivers from 10 different countries of origin, and 14 different languages, completed pre- and poststudy measures (42/46, 91% completion rate). Just under half (45%) of all users used the app more than once with an average visit of 4 min 8 seconds. Responding to the uMARS, 62% (26/42) of the participants said that they would recommend the app to many people. Nearly all (40/42, 95%) participants said that Driving to Health increased awareness of their own mental health; 86% (36/42) said that it increased their mental health knowledge; and 76% (32/42) said that it increased their self-help behaviors. Increases in help-seeking intentions on the GHSQ were not significant, and increases on all 3 scales of DASS-21 were not reliable or meaningful. Conclusions: This study suggests that Driving to Health is an acceptable and feasible electronic health intervention for a hard-to-reach population. Our findings also suggest that Driving to Health results in increases in mental health awareness, behaviors, and willingness to seek help.